| 1. |
- Jakobsson, Hugo, 1990-, et al.
(författare)
-
Pulp-to-palm distance after plate fixation of a distal radius fracture corresponds to functional outcome
- 2023
-
Ingår i: Archives of physiotherapy. - : BioMed Central (BMC). - 2057-0082. ; 13:1
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Several factors can influence the outcome after a distal radius fracture (DRF). The aim of this study was to assess whether postoperative pulp-to-palm (PTP) distance correlated with functional outcomes after plate fixation of DRF. MATERIALS &METHODS: This is a secondary analysis of a randomized controlled trial aimed to investigate the effects of plate fixation in patients with type-C fractures. Subjects (N = 135) were divided into 2 groups based on PTP distance (equal to or higher than 0 cm) at 4 weeks postoperatively. Outcome measures were collected prospectively at 3, 6 and 12 months and included Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores, wrist range of motion (ROM), Visual Analog Scale (VAS) pain scores, and hand grip strength.RESULTS: Overall, at 3 and 6 months patients with PTP > 0 cm had significantly worse outcomes (PRWE, QuickDASH, wrist ROM) than those with PTP =0 cm. At 12 months, QuickDASH and wrist ROM were still significantly worse. In the volar-plating subgroup, patients with PTP > 0 cm had significantly worse wrist ROM and grip strength at 3 months, but no significant differences were found in subsequent follow-ups. In the combined-plating group, patients with PTP > 0 cm had significantly worse QuickDASH, wrist ROM and grip strength at 3 months. At 6 and 12 months, wrist ROM was still significantly worse.CONCLUSIONS: Measurement of PTP distance appears to be useful to identify patients likely to have worse outcome after plating of a DRF. This could be a tool to improve the allocation of hand rehabilitation resources.
|
|
| 2. |
- Lundqvist, Eva, 1985-, et al.
(författare)
-
CT-Based Micromotion Analysis After Locking Plate Fixation of AO Type C Distal Radius Fractures
- 2023
-
Ingår i: Indian Journal of Orthopaedics. - : Springer. - 0019-5413 .- 1998-3727. ; 57:12, s. 2031-2039
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Volar locking plate fixation (VLPF) is the most common method for operative fixation of distal radius fractures (DRF). The dorsal ulnar corner (DUC) can be difficult to stabilize as the fragment is small and not exposed when using the volar approach. The purpose of this study was to study fracture fragment migration after VLPF of AO type C DRF, using a volume registration technique of paired CT scans with special focus on the DUC fragment.Materials and Methods: This pilot study included ten patients with AO type C DRF, all operated with VLPF. The primary outcome was radiographic outcome. Postoperative and 1-year scans were compared and analyzed. Fragment migration was assessed with CT-based micromotion analysis (CTMA), a software technique used for volume registration of paired CT scans.Results: All plates were stable over time. Two patients showed signs of screw movement (0.2-0.35 mm and 0.35- > 1 mm respectively). Postoperative reduction was maintained, and there was no fragment migration at the 1-year follow-up except for one case with increased dorsal tilt. The DUC fragment was found in 8/10 cases, fixated in 7/8 cases, and not dislocated in any case at the 1-year follow-up.Conclusion: The CTMA results indicate that variable-angle VLPF after AO type C DRF can yield and maintain a highly stable reduction of the fracture fragments. The DUC fragment remained stable regardless of the number of screws through the fragment. CT volume registration can be a valuable tool in the detailed assessment of fracture fragment migration following volar plate fixation of DRFs.
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Lundqvist, Eva, 1985-
(författare)
-
Distal radius fractures AO type C : A clinical and radiographic investigation
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The function of the hand is of substantial importance, and injuries have an impact on daily life. Distal radius fracture (DRF) is the most common fracture among adults. The annual incidence is 26 per 10,000 inhabitants, and the incidence is increasing because of an aging population. There has been a shift from conservative and other operative treatments, toward volar plate fixation to restore the anatomy and improve results. Operative treatment is often considered for displaced and unstable fractures. The optimal choice of treatment and fixation is still debated. The aim of this thesis was to study results after internal fixation of DRF AO type C.Study I (retrospective study, n=74) assessed outcomes after combined plating (CP) of DRFs AO type C, with 1-year follow-up. CP restored the anatomy and achieved a good functional outcome. The radiographic outcome did not correspond to the clinical or functional outcome.Study II (prospective study, n=97) assessed the prevalence of post-traumatic arthritis (PA) following CP of DRFs AO type C. CP yielded a good clinical outcome 7 years postoperatively and the prevalence of PA was low (29%). The presence of PA did not correlate with fracture group, radio-graphic, clinical, or functional outcome. Study III (randomized controlled trial, n=147) assessed the radiographic and clinical outcome following surgical treatment of DRFs AO type C, comparing volar plating (VP) with CP. Fixation with VP yieldedthe same radiographic and functional results as CP, but with a lower frequency of complications in the VP group.Study IV (prospective pilot study, n=10) assessed fragment migration with CTMA (CT-based micromotion analysis) after osteosynthesis with VP after DRF AO type C. The CTMA technique indicated that variable angle volar locking plate fixation can yield and maintain a stable reduction of the fracture fragments. CT volume registration could be a valuable tool in the detailed assessment of fracture fragment migration following VP fixation of DRFs.
|
|
| 6. |
- Lundqvist, Eva, 1985-, et al.
(författare)
-
Posttraumatic Arthritis After Combined Plating of Distal Radius Fractures AO Type C : A 7-Year Follow-up of 97 Cases
- 2022
-
Ingår i: Hand (New York, N.Y.). - : Sage Publications. - 1558-9447 .- 1558-9455. ; :Sup. 1, s. 50S-59S
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Volar locking plate fixation is the most common method of operative fixation of distal radius fractures (DRFs). For more complex cases, combined plating is an option for stabilizing intra-articular fragments. The prevalence of posttraumatic arthritis (PA) after an intra-articular DRF, and its relation to patient-reported outcome measures (PROMs), remains unclear. The purpose of this study was to study the prevalence of PA and its correlation to clinical outcome measures.METHODS: We evaluated 97 consecutive patients with intra-articular DRF, operated with combined plating, 7 years postoperatively. The primary outcome measure was the prevalence of radiographic PA. Secondary outcome measures included visual analog scale (VAS) pain score, hand grip strength, wrist range of motion (ROM), Patient-Rated Wrist Evaluation (PRWE) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographic examination was performed between 1 and 7 years postoperatively.RESULTS: The prevalence of PA was 29% at the 7-year follow-up. No correlation was found between PA and ROM, hand grip strength, PRWE, QuickDASH, VAS pain scores, or radiographic reduction. Median wrist ROM and grip strength were significantly inferior compared with the uninjured side. Hardware removal was performed in 51.5% of cases. There were 2 cases of tendon ruptures.CONCLUSIONS: Combined plating can yield a good clinical outcome 7 years postoperatively and a low prevalence of PA. The presence of PA did not correlate to clinical outcome measures or to the accuracy of anatomical reduction 1 year postoperatively. The frequency of tendon ruptures was acceptable, but the high frequency of hardware removal is a concern.
|
|
| 7. |
- Lundqvist, Eva, 1985-, et al.
(författare)
-
Pyrolytic Carbon Hemiarthroplasty for Proximal Interphalangeal Joint Arthritis, Long-Term Follow-Up
- 2024
-
Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier. - 0363-5023 .- 1531-6564. ; 49:2, s. 99-107
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to assess the long-term clinical, subjective, and radiographic results of pyrocarbon hemiarthroplasty for proximal interphalangeal joint (PIPJ) arthritis at a single institution.METHODS: Patients treated with a pyrolytic carbon hemiarthroplasty between 2005 and 2015 were contacted for a clinical follow-up visit. Patients were assessed before surgery, one year after surgery, and again after a mean of 11 years (range: 6-16 years). Objective outcomes were assessed with grip strength, pinch strength, and range of motion (ROM). Subjective outcomes were assessed by the Disabilities of the Arm, Shoulder, and Hand score, Canadian Occupational Performance Measure (performance and satisfaction), and Visual Analog Scale pain scores at rest and during activity. Radiographic assessments were completed according to Sweets and Stern as modified by Wagner et al.RESULTS: A total of 68 fingers in 52 patients underwent PIPJ hemiarthroplasty. Thirty-six arthroplasties in 29 patients were available for the long-term follow-up, five patients had died, and the remaining cases were contacted by phone. Three cases were lost to follow-up. Preoperative diagnoses included 41 fingers with osteoarthritis or posttraumatic arthritis, and 27 fingers with inflammatory arthritis. Eight cases had undergone revision at the time of follow-up, and the 10-year implant survival was 72%. The revisions were performed after a mean of two years after surgery. Three patients had undergone soft-tissue procedures. Visual Analog Scale pain scores, Disabilities of the Arm, Shoulder, and Hand scores, and Canadian Occupational Performance Measure scores improved significantly compared with that before surgery. Grip strength and pinch grip remained unchanged. However, PIPJ ROM deteriorated significantly one year after surgery, when compared with that before surgery.CONCLUSIONS: Pyrocarbon hemiarthroplasty of the PIPJ has an acceptable long-term implant survival, and the significant improvement in pain scores and patient-reported outcomes is maintained over time. Pyrocarbon hemiarthroplasty could be a viable option in the management of PIPJ arthritis. Patients should be advised that PIPJ ROM deteriorates over time.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
|
|
| 8. |
- Lundqvist, Eva, 1985-, et al.
(författare)
-
Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures : A Randomized Controlled Study of 150 Cases
- 2022
-
Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier. - 0363-5023 .- 1531-6564. ; 47:9, s. 813-822
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating.METHODS: In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score.RESULTS: Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group.CONCLUSIONS: In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
|
|
| 9. |
- Sagerfors, Marcus, MD, PhD, 1977-, et al.
(författare)
-
Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases
- 2020
-
Ingår i: Journal of wrist surgery. - : Thieme Medical Publishers. - 2163-3916 .- 2163-3924. ; 9:5, s. 388-395
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The distal radius fracture (DRF) is themost common fracture in adults. For unstable intra- articular fractures, the choice of treatment is often operative. The optimal choice of fixation remains a matter of discussion.Question/Purpose: Can combined volar and dorsal plating, using a dorsal frame plate, achieve a good functional and radiographic 1-year outcome in intra-articular DRFs? Methods In a retrospective cohort study, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate. The DRFs were operated between 2016 and 2017 and all cases were AO type C intraarticular fractures. The primary outcome was patient- reported outcome measures including radiographic examination 1 year postoperatively. Secondary outcome measures included wrist range of motion, visual analog scale (VAS) pain scores, and hand grip strength.Results: The median patient-rated wrist evaluation score was 18 points; the quick disabilities of the arm, shoulder, and hand score was 14.8 points. The median Batra radiographic score was 88. Wrist extension was 76% of the uninjured side, flexion was 74%, pronation was 94%, and supination was 94%. VAS pain scores were 0 at rest and 2 during activity. Hand grip strength was 82% compared with the uninjured side. The radiographic outcome according to Batra did not correspond to the patient-reported outcome. Patients older than 60 years had significantly better QuickDASH (quick disabilities of the arm, shoulder, and hand) and PRWE scores (patient-rated wrist evaluation scores) and less pain during activity compared with younger patients despite similar radiographic outcome. There were no tendon ruptures; hardware removal was performed in 21 of the 74 patients.Conclusion: The radiographic outcome did not correspond to the functional outcome 1 year postoperatively. Older patients report less pain and better functional outcome compared with younger patients. There were no tendon ruptures and the frequency of hardware removal was acceptable. Complex intra-articular DRFs AO type C can be managedwith volar and dorsal frame-plate fixation to restore distal radius anatomy and achieve a good functional outcome.
|
|
| 10. |
- Sagerfors, Marcus, MD, PhD, 1977-, et al.
(författare)
-
Combined Volar and Dorsal Plating for Distal Radius Fractures using a Dorsal Frame Plate, a Consecutive Series of 74 AO type C Cases
- 2020
-
Konferensbidrag (refereegranskat)abstract
- Introduction: The distal radius fracture (DRF) is the most common fracture in adults. For unstable intra-articular fractures, the choice of treatment is often operative. The type of operation and optimal choice of implant remains a matter of discussion.Materials and Methods: In a retrospective cohort study, following ethical approval, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate (Medartis AG.). The DRFs were operated between 2016 and 2017. All cases were AO type C fractures. The primary outcome was patient reported outcome measures including radiographic examination one year postoperatively. Secondary outcome measures included wrist range of motion, VAS pain-scores and hand grip-strength.Results: The median Batra radiographic score was 88. Median wrist extension was 76 % of the uninjured side, flexion was 74 %, pronation was 94 % and supination was 94 %. The Patient-Rated Wrist Evaluation-score was 18 points, the Disabilities of the Arm, Shoulder and Hand-score was 14.8 points. VAS-pain scores were 0 at rest and 2 during activity. Hand grip-strength was 82 % compared to the uninjured side. There were no tendon ruptures. Hardware removal was performed in 21 of the 74 patients. The radiographic outcome according to Batra did not correspond to the patient-reported outcome.Conclusions: A good functional and radiographic outcome can be anticipated after combined plating of AO type C DRFs. The radiographic outcome does not necessarily correspond to the functional outcome one year postoperatively. The frequency of hardware removal was acceptable. Complex intra-articular distal radius fractures AO type C can be managed with combined volar and dorsal frame-plate fixation to restore distal radius anatomy.
|
|
